Independence Blue Cross (IBX) is committed to finding innovative ways to make specialty drugs more affordable while ensuring members have access to the medications they need.
That's why IBX is closely monitoring the launch of biosimilars for two key drugs, Stelara® (ustekinumab) and Actemra® (tocilizumab).
Effective July 1, 2025, IBX will be implementing the following updates to both its medical and prescription drug programs:
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Yesintek (ustekinumab-kfce) will be the preferred biosimilar for Stelara®.
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Tyenne (tocilizumab-aazg) will be the preferred biosimilar for Actemra®.
How will this affect your patients (our members)?
Stelara
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Pharmacy Benefit:
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Stelara SQ will be removed from the IBX Value formulary and will be considered non-formulary. For the Select formulary, Stelara SQ will no longer be preferred.
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The preferred ustekinumab product will be Yesintek (ustekinumab-kfce), a lower-cost biosimilar of Stelara. Members will be notified of this change by mail.
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IBX members will be able to access Yesintek from their existing pharmacy or from a partnered specialty pharmacy. Access details will be shared soon with IBX members and providers.
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All existing authorizations for Stelara will be transitioned to Yesintek beginning
July 1, 2025.
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Medical Benefit:
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Stelara SQ and Stelara IV will be non-preferred. All existing authorizations for Stelara will be transitioned to Yesintek beginning
July 1, 2025.
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Providers can transition all SQ formulations to the pharmacy benefit. Members with an IBX pharmacy benefit will switch to Yesintek, while those with a different pharmacy benefit manager (PBM) will transition based on their specific benefits.
Actemra
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Pharmacy Benefit:
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Actemra SQ will be removed from the IBX Value formulary and designated as non-formulary. On the Select formulary, it will remain a non- preferred option.
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The preferred tocilizumab product will be Tyenne (tocilizumab-aazg), a lower-cost biosimilar of Actemra SQ. We will notify our members of this change by mail.
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IBX members will be able to access Tyenne through their existing pharmacy or a partnered specialty pharmacy. More access details will be shared soon.
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All existing authorizations for Actemra will be transitioned to Tyenne beginning
July 1, 2025.
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Medical Benefit:
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Actemra IV will be non-preferred. All existing authorizations for Actemra IV will be transitioned to Tyenne beginning
July 1, 2025.
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Providers currently offer only the intravenous (IV) version under the medical benefit but can provide SQ formulations under the pharmacy benefit. Members with IBX pharmacy benefits will switch to Tyenne, while those with a different PBM will transition based on their PBM coverage.
Details with IBX members and prescribing providers will be shared soon, including steps on how to access the biosimilars.
Why are these changes happening?
IBX is constantly evaluating best practice standards and industry trends to help manage specialty drug costs. Stelara and Actemra are widely used biologics that drive significant specialty drug costs. The U.S. Food and Drug Administration (FDA) has approved several biosimilars for these drugs, confirming they match the originals in safety and effectiveness.*
Designating preferred products allows IBX to take advantage of the growing availability of biosimilars, as well as competition between biosimilars and reference products. This competition may help reduce costs and expand members' access to more affordable therapies.
Policy Updates
The IBX Commercial medical policy and pharmacy policy for Stelara and Actemra will be updated to reflect the new coverage criteria for preferred products.
*U.S. Food & Drug Administration. “Biosimilar and Interchangeable Products." 2017. Available from: https://www.fda.gov/drugs/things-know-about/9-things-know-about-biosimilars-and-interchangeable-biosimilars
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